Supreme Court's Decision on Health Insurance Law Has Implications for People with Disabilities

The U.S. Supreme Court recently heard three days of oral arguments in a series of cases challenging the constitutionality of the Patient Protection and Affordable Care Act, which was passed by a divided Congress in 2010. The Affordable Care Act, also known as Obamacare or the Universal Health Insurance law, guarantees affordable health insurance to almost all Americans, including people with pre-existing medical conditions and low-income people with disabilities who may not already qualify for Medicaid or Medicare. If the Supreme Court throws out all or part of the law, people with disabilities could lose some very important benefits.

The Affordable Care Act is a massively complicated law, but at its core the law provides health insurance to people who currently don't have it through several mechanisms.

All three of these provisions affect people with disabilities, especially young people and those who have low but not super-low incomes, because under these provisions they will be able to access low-cost insurance that was not previously available. Finally, the law requires all citizens who do not qualify for government-sponsored health insurance to obtain private health insurance, which could be provided through work or purchased for an affordable price through insurance exchanges that are subsidized by the government. If a person does not obtain health insurance either through the government, employment or on her own, then she would incur a substantial tax penalty, usually the loss of her tax refund. This requirement is known as the "individual mandate."

A coalition of business groups, private citizens and state attorneys general challenged the Affordable Care Act in court, alleging that it exceeded the scope of Congress's powers. The Supreme Court heard three days of oral arguments on various aspects of the case. On the first day, the Court considered whether it was premature for it to hear the case at all, since taxpayers have not yet been penalized for failing to purchase insurance. (The requirement doesn't begin until 2014.) On the second day, the parties debated whether the government could require citizens to purchase private health insurance under the Commerce Clause of the Constitution. On the last day of arguments, the Court questioned the scope of the law's Medicaid expansion (essentially asking whether Congress can require states to expand access to Medicaid or lose all federal Medicaid funds) and it also sought to determine whether the entire law should be thrown out if the Court decides that the individual mandate is unconstitutional.

People with disabilities will be effected in different ways depending on the scope of the Court's ruling. If the Court throws out the individual mandate but keeps the rest of the law intact, as many observers are now predicting, then most of the provisions relating to people with disabilities will remain in effect. However, if the Court decides that the entire law cannot stand without the individual mandate, then people with disabilities will lose all of their benefits under the law, including the pre-existing condition rules and the ability to stay on a parent's health insurance plan until the age of 26. If the Court decides that portions of the law are constitutional but finds that the Medicaid expansion provisions are unconstitutional, then many people with disabilities who might be able to qualify for Medicaid under the expanded eligibility provisions will once again become ineligible for benefits.

A decision is expected by June.

To read The New York Times' informative summary of the law and the litigation, click here.

To read the briefs or hear all three days of oral arguments, click here.